Probiotics for Depression and Anxiety with Dr Adrian Lopresti

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Probiotics for Depression and Anxiety with Dr Adrian Lopresti

Where do probiotics rank in your prescribing hierarchy for mood disorders such as anxiety and depression?

As we deepen our understanding of the gut-brain connection, what's becoming clear is that probiotics may have a powerful role to play in the management of mental health conditions. 

Today we are joined again by clinical psychologist and researcher Dr Adrian Lopresti to help navigate us through the emerging research in this area. Adrian will help to clarify how probiotics are being shown to influence mood, how to select appropriate probiotics and how to incorporate probiotic-containing-foods and herbs as part of a treatment plan for addressing anxiety and depression in patients.

Covered in this episode

[00:40] Welcoming back Dr Adrian Lopresti
[01:36] Emerging research connecting probiotics and mood
[05:08] Diet and mood
[08:06] Choosing the right probiotic
[09:20] Pharmacological treatments vs natural interventions
[11:15] The importance of handouts and resources for the patient
[13:44] Neurotransmitters and the gut
[15:23] Establishing a “normal” microbiome
[17:47] Targeting the microbiome
[20:21] Using fermented foods
[22:49] Other nutrients and foods that can improve the gut microbiome
[25:42] Researching therapeutics in healthy vs clinical populations and the power of the placebo
[30:33] Additional gut soothing foods and herbs
[31:56] Adrian’s preferred strains
[35:14] Probiotic containing foods
[36:13] Further resources for practitioners
[39:45] Closing remarks


Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook. Joining us on the line again today is Dr Adrian Lopresti. He's a clinical psychologist in private practice, managing director of his own contract research organisation, and senior researcher at Murdoch University Western Australia. He has over 20 years of clinical experience working with children and adults suffering from a range of mental health conditions. He has experience in a range of psychological therapies and has received extensive training in nutritional and lifestyle treatment for mental health disorders.

Dr Lopresti regularly publishes in peer-reviewed, high impact journals on numerous disorders and has completed several clinical trials, investigating the effects of curcumin, saffron, and ashwagandha in the treatment of anxiety and depression in children and adults. Welcome back to FX Medicine. Adrian, how are you?

Adrian: Good, Andrew. Thanks for having me back.

Andrew: Now today we're going to be discussing something that isn't often attributed to a treatment with mood disorders, depression, anxiety, and that's probiotics. So I guess we got to start, what's the current research showing with regards to the effects of probiotics on depression and anxiety?

Adrian: The research certainly is accumulating, certainly there's more and more interest about the gut-brain connection and its potential in terms of influencing depression and anxiety. And obviously, there's been increasing interest looking at the potential impact of probiotics as antidepressants or anti-anxiety agents. And there's some recent reviews that have been completed and published, which indicate that probiotics certainly may have some benefits in improving depression in adults. There's less research in relation to anxiety, but certainly, there's certainly some positive data coming out there.

Andrew: One of the things that's always interested me is something I learned from being an integrative medicine practitioner, and that was 95% of our serotonin is not made in our brains, it's made in our gut by our enterochromaffin cells.

Adrian: Yeah, that’s the thing. That's the thing that often people forget to keep in mind is that, yes, most of our serotonin is produced in the gut, not in the brain. Now what impact that has on cognitive function and mental health, we're not quite sure. But certainly, there's lots of neurotransmitters, not just serotonin, but other neurotransmitters that are also produced in the gut, and then maybe had far-reaching health effects.

Andrew: So how do probiotics work to promote or support mental health? I guess my question here is, we're talking about the gut-brain axis, but the feelings of depression and anxiety, I know the visceral effects. But the depression symptoms, if you like, are purported, or the target tissue is the brain. So there's that lag time, is it, between what you give the gut, how does it affect the brain? So I'm wondering, how strong is the effect of probiotics here?

Adrian: I mean, the effects seem to be... So I suppose with a lot of the probiotic research that's been conducted, a lot of the research has actually been conducted on healthy individuals. And what they're looking at is, you know, does giving probiotics improve mood in healthy individuals? Unfortunately, you're not going to see dramatic changes because they're already know, the mood is already pretty good to start off with.

But those studies where they've actually used probiotics with people with clinical forms of depression, then we're actually seeing, you know, moderate effects of probiotics on mood. So certainly it's not a magic pill, and I think it's part of an integrative, holistic approach. It could be used as an extra tool to help improve people's mood. 

Obviously, we need to look at other stressors that are going on, we need to look at diet. And we got to be careful about that then thinking, “Okay, probiotics is this magic pill that we can just give everybody.” But it could be an adjunct or an additional treatment option for people who are working with mental health sufferers.

Andrew: So you know, you mentioned diet there, and Felice Jacka has done some awesome workup. Indeed, you've worked with Felice Jacka, correct?

Adrian: I've written a paper with Felice and certainly, yeah, she's done some amazing work looking at the impact of diet and the relationship between diet and depression, anxiety, bipolar disorder. And she's also done some really nice research, looking at the Mediterranean-based diet as a treatment for depression, which came out with some really positive results.

Andrew: So then we've got the food modulating the gut microbiota, we know that a plant-based diet affects the microbiota within days. Where do we place probiotics here, I guess, as a strategy or as a priority? The diet, it's got to be first, right?

Adrian: The diet is got to be... Well, absolutely, the diet has got to be first. But the problem you've got is that when you're experiencing low mood or when you're experiencing anxiety, making dietary changes can be extremely difficult. 

Andrew: Right.

Adrian: So ideally, yes, let's eat a plant-based diet, let's drink more water. Let's increase our kind of lean protein and good fats and things like that. But when you're struggling to get out of bed and you've got no motivation to do anything, your energy is low, you're sleep deprived. It's extremely difficult to then spend time, kind of dedicating time to improving your diet.

So while I absolutely believe that diet is an integral part, maybe for some people, they're not quite ready yet. And that's where you can look at maybe, let's look at kind of supplements or probiotics to help them along the way, even if probiotics could potentially improve their mood by 10%, that will then make it easier for them to incorporate dietary changes.

Andrew: Got you. And I guess this is part of your personalised integrative therapy, correct?

Adrian: Yeah, it's really looking at identifying the potential causes of what's contributing to somebody's mental health problems, whether it's diet, stress. And we need to be very individualised for some people. Their diet is really, really good, and dedicating a lot of effort towards improving that diet any further might not result in dramatic gains. 

Andrew: Right. Right.

Adrian: But who knows, maybe they've got some abnormal changes in their microbiota profile, whether they've then had a long history of antibiotic use or things like that. And maybe probiotics can potentially help them. But we're not quite sure who probiotics work best for and we're still far… We still need to look into that in greater detail. Maybe it works better with people with digestive problems, maybe it works better with...

Andrew: I see.

Adrian: ...people with a history of antibiotic use. We're not quite sure.

Andrew: All right, so I'm going to ask you the question, how do you choose the right probiotic?

Adrian: Well, yeah, this is the thing. It's... I mean, for me, I'm looking know, I do really a good assessment just to try to determine how much do I think the gut could potentially be impacting our mood? Where would I need to put my effort towards? Is it that there's lots of stress going on in somebody's life and that's really where I need to dedicate my energy towards? And is it that there's other medical conditions, chronic pain or things like that, that maybe we need to kind of work on first? Is it, you know, some coping skills that we need to work on? Or is it they're not exercising or they're not sleeping, and we need to work on that stuff first?

But generally, you know, when there's ongoing stress, you can probably pretty much assume that the gut is probably having an effect because stress will certainly affect the microbiota and it can also lead to kind of leaky gut and things like that. So if we can give something either through dietary intervention or probiotics to help kind of improve that kind of gut-brain communication, then maybe it's something worth looking at.

Andrew: Okay, you mentioned assessment and, obviously, there's a scale of severity there. So when would you prioritise that we really need to be looking at acute, even pharmacological treatments, over lifestyle and other interventions?

Adrian: Well, I mean, when we look at your pharmacological treatments, and, yeah, the research seems to indicate that that works better for more your severe form. And I think that when somebody is coming in with severe depression, and they're just lack the drive, or motivation to, or energy to make any changes, and then that's when then certainly, I think, pharmaceutical medications may be a benefit initially. If we can just reduce the intensity of the symptoms by 20%, for example.

And then once they're at that stage, then maybe they're ready to incorporate some behavioural changes. So that's very individualised. And a lot of it, it's about me doing my thing and going, “Okay, what changes do I think need to occur for this individual sitting across from me?” But also then going, “What changes are they able to make? What changes are they willing to make?”

And also, one of the things that still...while more and more understanding about the gut-brain connection is occurring, it's still quite a foreign concept for a lot of people. “How can the gut affect our mood? They’re two different organs,” is what people are still at. So we need to make sure that we're educating people for them to understand how the gut can affect the brain. And I do a lot of psycho-education first and provide them with as much information. I've got lots of resources and booklets that I give them that help them to understand why we're doing what we're doing.

Andrew: I got to say, this comes up time and time again, the well-prepared practitioner has good handouts to give to their patients so that they themselves can take charge of their condition and be empowered. It's really important, isn't it?

Adrian: It absolutely is. I mean, this is the other thing. You've got somebody who's depressed, anxious, I mean how much are they actually hearing what I'm saying? 

Andrew: Yes.

Adrian: And how many of them walk out of the office and they go, "What was actually covered?" And maybe they didn't hear as much as I thought they heard. So it's really important for me to then give them some information, some written information, or even getting them to watch videos or YouTube clips that provide some further consolidation of what we talk about. 

Because they're not going to remember a lot of the stuff that we've talked about. And I have lots of clients who come in and they've said they've seen other practitioners and I go, "What did you cover with them? What things were discussed?" And they go, "I don't know."

And if you can give them...I've got a workbook, tiny, just small workbooks for the gut-brain connection. I've got one for sleep, I've got one for physical activity, I've got one for diet, nutrition side of things. And just give them just a handout that they can then take away, they’ve got it there, that they can refer back to. And in there, these activities, usually I have checklists and questionnaires that they can go to help them to incorporate changes for themselves.

Andrew: And I guess this would be really important when we're dealing with conditions that require support, family support, significant others support. So these handouts would be so important in educating them so that they're aware, at least, of what sort of track you're taking.

Adrian: Yeah, absolutely. So, again, if you think about the gut-brain stuff, if we're working on the gut to improve somebody's depression, and they're going to a party where there's family members and they kind of go, "I'm trying to eat healthy because I'm trying to improve my mood," for example. People are going to be sitting there, "How is that going to affect your mood? Just take an antidepressant, that will fix it." And if they don't understand, they're not going to provide that support that that person needs. So it's really important that people can have the resources so they can also educate family members and other social connections and things like that.

Andrew: Can I just delve a little bit into what you said there with regards to an antidepressant? You know, these are very commonly drugs that prevent the reuptake of a neurotransmitter at the synapse, therefore leaving the neurotransmitters there at the synapse to do their job. But it doesn't make the neurotransmitter to be released. This is nutrition, isn't it?

Adrian: Yeah, this is nutrition, this is the gut. We know that certainly, obviously, you need protein, and you need the nutrients, the vitamins, the minerals that help to produce those neurotransmitters. And even the microbiota, we're seeing that things that kind of degrade serotonin are stress hormones, cortisol. And we know that the gut, the microbiome can affect our levels of cortisol. So potentially, by treating the gut, you're reducing cortisol, and, therefore as a consequence of that, you're increasing serotonin. We know that the vagus nerve can also have an impact on neurotransmitter activity and the microbiome impacts on the vagus nerve.

Andrew: Of course.

Adrian: You've got GABA which also affects tryptophan metabolism. So again, you target the microbiome and you're potentially increasing neurotransmitters there. The gut is a form of… It could be a form of inflammation going on, and we know that inflammation will lower serotonin production. So while potentially treating the microbiome, potentially treating the gut, you're reducing inflammation and as a consequence, you're increasing serotonin and other neurotransmitters.

Andrew: Now, of course, you know, we're talking about the microbiome, microbiota of the gut. And a dysfunctional microbiota is what we'd call dysbiosis. Then there's this issue of what bugs help the gut to make the neurotransmitters, and what bugs are detrimental to that balance, if you like? So that comes into measurement, that comes into assessment. And I really question whether we're here yet with regards to what is a “good” or a “normal” microbiome. What's your opinion there?

Adrian: Yeah, you're right, absolutely, you're right there. I think trying to identify the perfect microbiome is... We're not going to be at that stage. And I think it's very culture-dependent too, depending on what we're eating and things like that. 

Andrew: Ah, yes. Yes.

Adrian: But I think it's kind of the general consensus is that we need to ensure that we've got diversity in our gut microbiome. 

Andrew: Right.

Adrian: And so, if I, for example, did a test on the microbiome, I'm really kind of looking at diversity and that's probably my initial measure there. So if you're looking at any particular strain of bacteria or things like that, then I think we're certainly not there yet.

Andrew: Yeah, like, you know, we'd like to use the strain that works, the best strain, but it appears that the research is using vastly different species and strains here.

Adrian: Yeah, this is the thing, when you're looking at probiotics, you know, obviously, if I do research on saffron for depression, I know that it's saffron that I'm giving. If I'm doing a... If you're looking at some of the ratios on probiotics, you're looking at very different strains, the species and strains that might be kind of administered. And so, is it probiotics or is it the strain that was important? And which one should you give? And how much should you give? And for how long should you give? And we don't know.

The research, from general rule, if you're looking at probiotics in general, it kind of works... it needs to be given for at least four weeks, that's where kind of the research seems to be indicating. But I'm not confident in going, "This form of probiotic is better than another one." I don't think there's enough evidence there to lean one way or the other.

Andrew: Okay. What about those that might be favouring the small intestine versus the large intestine, i.e. the Lactobacillus versus the Bifidobacterium? That's oversimplified, way oversimplified, but just to give an idea, do you tend to choose one over the other?

Adrian: Well, the review that recently came out, I mean, basically, it was the...what they kind of concluded...and again there was limited kind of research to form definitive conclusions. But what they seem to think was that the combination of the Lactobacillus with the Bifidobacterium, for example, together that seemed to work best, but there wasn't a lot of research there. And there's another study that was done for women with postnatal depression, and then they looked at Lactobacillus rhamnosus, and that one seemed to work really well for them. But, you know, would the combination work even better? I don't know.

Andrew: Now, was that a particular strain of rhamnosus? Was that the GG?

Adrian: Yeah, the one with postnatal depression I think was the HN001, I think it was, for that one, that was quite a big study that was done.

Andrew: And, of course, something I'm mindful of is, you know, people with depression often have poor sleep, we know that sleep affects microbiota. So it's kind of like, where do you start? How do you tease it apart? Where do you intervene?

Adrian: Yeah, that's exactly right. Again, this is where you look at that integrative approach. It's kind of going, ”What potentially is going on?" And, you know, we know that sleep will affect the microbiota, we know that sleep will affect neurotransmitters, we know that sleep will affect cortisol production, we know that sleep will affect inflammation. And then all those factors have been associated with depression and anxiety. But then on the same, you know, also if we think about exercise, we know that exercise, again, does all those things too. So potentially, you could treat the microbiome through exercise.

Andrew: Yes.

Adrian: We know that stress does all that, so you could potentially treat the microbiome through stress reduction. So it's not just diet, although I think if you want to target the microbiome, it's through diet and obviously, incorporating lots of probiotics and things like that, food, time, probiotics. But you can certainly target the microbiome through stress reduction, through exercise, through sleep, and all those different factors.

Andrew: When we're talking about diet, and, you know, I mentioned a plant-based diet, and yet there's these fermented foods as well, that are favoured by certain cultures like the kefir, the kimchi, the sauerkraut, that sort of thing. Do you tend to encourage the use of fermented foods as well as, or as a starting point, or is it more than sort of the plants, just the plant intake?

Adrian: I mean, really, it's, I go, "Here are your different options. We can kind of improve the gut-brain connection through all these different ways, and one of them is through increasing certain plant-based foods, or fermented foods, or probiotics, or prebiotics." And I kind of present that to them, and then they make that decision. I mean, I'll probably...because I personally don't eat a lot of fermented food, so that's probably impacting on my bias, you know, I'm kind of sitting here telling people to eat fermented foods and I don’t. Although it's probably beneficial for me to do that and for others to do that.

But really it's kind of know, some people of some certain cultures, they go, "Fermented foods, great. I'm really interested in incorporating that and I can definitely do that." And then you've got others who look at me weirdly…

Andrew: You mean rotten plant stuff?

Adrian: So, again, it's like present the options and go, "Look, here are ways that we can target the microbiome and which ones are you..." Well, firstly, here, you provide education about the connection and how we can improve the brain by improving the gut. And then once you've then done that and they understand that process and how it could potentially improve their mood, then you go, "Now here are some ways that we can improve your gut, and where do you want to start?"

And maybe it's two or three changes that they set in the first week. And then they kind of...and they set... You know, I'm very much into getting people to set real specific goals, you know, your SMART goals. What is it that you're going to do this week? What changes are you going to do? And let's kind of put them down and let's just target those first. And then they come back the following week, and we see how they've progressed with that. And then we might either modify the goals or add new goals, just depending on where they're at.

Andrew: You know, I've never heard of probiotics instigating a serotonin syndrome episode. But what other strategies or nutrients do you favour? Do you tend to use to support this gut-brain connection, i.e. the manufacture of these neurotransmitters? Like, for instance, 5-hydroxytryptophan, you mentioned tryptophan. Do you ever use these sort of agents as well as probiotics?

Adrian: I personally don't use 5-HTP only because in WA, it’s not a listable.…

Andrew: Of course.

Adrian: …usable product. So I'm really kind of careful from an insurance point of view to certainly do that. I mean, the thing that we've got to keep in mind is there's several ways we can target the microbiome, and even things like omega-3s. So I'm very much know, that seems to have an impact on the microbiome. So fish oils, magnesium, there's been some research there that also shows that it can alter the microbiome. And my theory around curcumin around its impact...its mood-enhancing effects is a lot of... there's an issue around bioavailability.

So curcumin and saffron, maybe it works by altering the gut microbiome. So you can use herbs and spices. So it doesn't have to be... And then, obviously, you're altering the microbiome and then you're reducing inflammation, and then, as a result you're increasing serotonin production in the brain.

Andrew: Okay, any other nutrients or food-type medicines that you'd use?

Adrian: Yeah, sometimes with some clients, particularly if they struggle with making significant changes in their diet, I'll use kind of prebiotic supplements like inulin and lactulose and things like that. So there's been some research looking at the effects of prebiotics as an antidepressant, and the research hasn't been that great. But, again, those studies have been on healthy people and looking at their mood-enhancing effect in healthy people. So whether the use of prebiotics in people with clinical depression or clinical anxiety can have an effect.

But I think  simply adding... I often get my clients to actually create a...have a what I call a “mood-boosting smoothie” every day. Where they put some protein in, they put some inulin powder or whatever it is they might use, you know, berries and healthy fats. And they just create a nice smoothie that's potentially increasing your B vitamins and your proteins, but also providing some nourishing food for the gut.

Andrew: With regards to research on healthy individuals, look, I can understand with a drug, you want to show a pharmacological effect, i.e. a forcing of that agent to change biochemical processes. But when we're talking about foods which nurture and nourish our system, they don't force us to do stuff. I wonder about the relevance of doing research on, say, a probiotic in a healthy individual who doesn't necessarily need it.

Adrian: Well, I think a lot of that has got to do with the claims that companies can make, unfortunately. I think that there's a… If you use an ingredient on a clinical population, you can't make claims. So the research has to be done on a healthy population so that way the company can make claims on their product. 

And so if I had an ingredient and I did a study on people with clinical depression, the TGA is not going to allow me to make claims on that group because they were a clinical group. I can only make claims and say, "Look, this has no effect on improved mood in healthy individuals." So this is the problem that we have, is that if you want to make claims from a supplement point of view, you need to do it in a healthy population.

Andrew: That seems nonsensical, doesn't it?

Adrian: It does, yeah, this is a problem. A lot of the studies, if you've been kind of...our company and you're going, "Okay I want to do a clinical trial on my product," if you use a clinical population, then you're not going to be able to make a therapeutic… because you can't make those high-end claims.

Andrew: So let's go into that. When you're looking at research that's been done on probiotics and you're saying, "Okay, well this is a fair trial, that's a fair trial." Do you look at these and pick them apart and look at bias and things like that?

Adrian: Yeah, I mean, absolutely, you have to. The problem we've got is that it can be quite difficult if you don't know how to unread research and try to understand the study design, and you pick at it and even the statistical analysis that they use. You need to have a bit of a background to be able to understand that. And I certainly do, when I'm seeing a study, I'm seeing a paper, I'll read through the paper and go, "Okay, what was the design like? What analyses did they use? And obviously, who funded, the company that funded the study?" But the problem with that is, who else is going to fund the study? So there's always going to be the element there. But was it a good designed study, and were the conclusions appropriate?

And you got to be careful because sometimes I see on the Internet, that this ingredient had a significant effect on mood or whatever it might be. And then I look at the study and it was a really weak study. And that's where you need to make sure that if you see a study, you see some of the claims, you know, just look into it in a bit more detail. I think it's very difficult to make conclusions on open-label studies, so there's no placebo control or some type of control group. Because we know that just the passage of time results in improvements in mood.

So if I see, for example, one on magnesium, which I believe that magnesium has benefit. But a lot of the studies are open-label studies. And I know from my work, from my research that just putting people on a placebo, they get 20 to 30% better. So, we need to make sure that there's some sort of control group.

Andrew: Yeah, and I guess you're in a particular profession where, because you're dealing with emotions, placebo is going to be a massive impact, isn't it?

Adrian: Yeah. I mean, certainly, placebo... there's research showing that placebo actually kind of changes certain hormones and things like that. So we're seeing that effect. And the other thing that happens is just the passage of time. The research shows that...I think it figures are that, you know, 20% to 30% of people with depression will experience a remission over 3 months just with the passage of time.

Andrew: Got you.

Adrian: And then over a year about 50% of people will experience a remission in their depressive symptoms over a year. So a lot of people just get better with time. Now, whether that's things that they then changed, or whether the stressor that was triggering the depression or anxiety has been resolved, but time is a pretty effective treatment too.

Andrew: Can I just go back to other things that you use, other strategies to support the gut-brain connection? What about soothing foods or even soothing herbs? And I guess, I'm thinking here with regards to, for instance, gastrointestinal upset with anxiety. You're not necessarily treating the anxiety, but you're soothing the GI upset. Do you tend to favour those sort of foods and herbs, like soups, or herbal formulae with bitter candytuft in them, you know, that sort of thing?

Adrian: Yeah, I think...I've talked about the microbe dysbiosis and potentially that affecting on mood and then, obviously, there's your gut inflammation and your leaky gut. Which also, some research is indicating that people with depression and anxiety have leaky gut. 

So it's really important to provide those soothing foods and even supplement formulas, things like your glutamines and the aloe veras and things like that. The different combinations of those herbal ingredients, which can be quite a soothing anti-inflammatory for the gut and may potentially help improve intestinal permeability or that leaky gut. So, absolutely, I think that they can be a component of someone's intervention, for sure.

Andrew: We were mentioning before about the various doses, strains, species, in the various products, the plethora of products that are coming out on the market now, with regards to probiotics for the use in depression and anxiety. So, what's your preference? Do you go in hard, or do you gently nudge things along?

Adrian: With the probiotics thing?

Andrew: Mm-hmm.

Adrian: Yeah, with the probiotics, at the moment, I'm probably choosing one with multiple strains in there. So that's where I'm kind of leaning towards at the moment. There's been a couple of studies for depression where they've used just for people the Lactobacillus helveticus R0052 and the Bifidobacterium longum R0175. There's been some nice studies looking at those for depression. So if there's a product that contains those strains I might lean towards that one there.

There's a really interesting study, which was published looking at the probiotic treatment for bipolar disorder. Yeah, and this one is really interesting because what they did was people after they were released... they went to the hospital because of the manic episodes or the depressive episode. And then they were given...after they left hospital they were given a probiotic for 24 weeks and they wanted to look at re-hospitalisations over that 24-week period. And what they found was that by giving them the probiotic, it reduced the rates of re-hospitalisation.

So I think I've got here that, you know, there was 24 people on the placebo re-hospitalised over this period, versus only 8 on a probiotic. So the significant reduction in re-hospitalisation and even their length of stay in hospital was significantly lower. So the people on the probiotics, they stayed in the hospital for about eight days and...sorry, the people on the placebo stayed in hospital for about eight days, and then those people on a probiotic were only in there for about three days. So it reduced the re-hospitalisation rate and the length of time in hospital. And the one they used was Lactobacillus rhamnosus strain GG and the Bifidobacterium animalis lactis strain BB-12. There's a nice study there, I'm happy to send you a link to that.

Andrew: Yeah, I'd love to put them up on the FX Medicine website. I was also noting the species and strains that you mentioned was in a paper by Wallace that I was looking at. "The Effects of Probiotics on Symptoms of Depression," the helveticus and the Bifidobacterium longum, yeah, so that's great.

Adrian: Yeah. So there's been, I think, a couple of studies on those combinations. If you can find them and can use then great, otherwise, I just kind of go, "Okay, let's look at a good quality company with some good strains in there and mix it up and see how we kind of go from there."

Andrew: What about probiotic-containing foods, yogurts?

Adrian: Yes. Absolutely. You know, certainly, if we can get people to have... for a lot of people, that might be the starting point, is you think like yogurt. I'm not overly confident about... Can you buy your kimchi drinks in Woolworths and things like that these days? I'm not sure how great they are. But think…

Andrew: Give me the kimchi.

Adrian: Or kombucha. I can't remember, I think it was kombucha or something like that.

Andrew: Yeah, you can buy kombucha

Adrian: Yeah, but I don't know how much of a…

Andrew: Yeah. What's the therapeutic value?

Adrian: But I think people can make their own and they can't ask me for the recipe because I've got absolutely no idea how to do it.

Andrew: Well, with kimchi, there was something like 110 official recipes, so.

Adrian: Really?

Andrew: Yeah, something like that. So further resources, Adrian, like you've got your personalised integrative therapy, and you run that as a course for people interested. Is that only available to psychologists?

Adrian: No, certainly it's available to anybody who's interested, who works with people with depression and anxiety. I've got a two-day course that I've specifically developed for people with...for mental health practitioners. I'll probably design one more also for your naturopathic practitioners because, I think the course needs to change a little bit. But I'll probably start that in 2020 or something like that.

Andrew: Got you.

Adrian: And then I've also got a workbook that I've developed that's got lots of exercises and resources in there. And I also got little workbooks that just target different modules. So if you want to then give people just the information on the diet, or if you want to just give them a little workbook on the gut-brain connection, then you can certainly purchase them and give them to your clients.

Andrew: I've got to tell you that I've looked at your session one in your workbook, you may not know about this, and it's brilliant, it's absolutely brilliant. You've done really good work here.

Adrian: I've got a study that I'm doing at the present moment. We're at week nine at the moment of the study and we're examining the effects of the personalised integrative approach for the treatment of people with depression and anxiety. And we're comparing the integrative approach with cognitive behaviour therapy. 

It's only a small pilot study but we've got three groups, we've got a cognitive behaviour therapy group, a PI therapy group, and a PI therapy plus supplements group. And we're comparing changes over time in relation to mood, but also even dietary changes, and physical activity changes, and sleep changes, and seeing how they go. So I hope that by early next year, we can have that fully published.

Andrew: I really would like to give you an accolade here and that is, I'm so impressed by the way that you like to bring objective measures into how you're assessing change in your patients. Because, particularly when we're looking at a strategy like probiotics. Unless you're in the research world, it's very not often looked at in an objective manner. And it just impresses me how you like to say, "Okay, well, what is the percentage increase or decrease in symptoms?" So that you can track the data over a period of time and say, “Yes, this is a valuable tool in your armamentarium to help people with mood disorders,” or not. I love it, it's fantastic.

Adrian: Well, we've got lots of options. And I think it's good if you can have some objective measures that you can share with your clients, and then that provides some good feedback for them, too. Because it's also very difficult. If your mood drops by 20% and you're still depressed, it's very difficult to notice that. You know, it might be, "Yeah, I'm better, but I just can't remember how bad I was two, three weeks ago." If we can kind of go look at the changes that are occurring gradually over time, it can be useful to have those objective measures.

Andrew: Yeah, well done. Adrian Lopresti, thanks so much for taking us through the options, the therapeutic options that we have now for depression, anxiety with regards to probiotics.

Adrian: Not a problem. Thanks for having me, Andrew.

Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.

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Dr Adrian Lopresti

Dr. Adrian Lopresti is a Clinical Psychologist in private practice and senior researcher at Murdoch University, Western Australia. He has over 20 years of clinical experience working with children and adults suffering from a range of mental health conditions.

Dr. Lopresti has experience in a range of psychological therapies and has received extensive training in nutritional and lifestyle treatments for mental-health disorders. Dr. Lopresti regularly publishes in peer-reviewed and high-impact journals on the effects of diet, nutraceuticals, sleep, and exercise for the treatment and prevention of depression, anxiety, attention deficit hyperactivity disorder (ADHD), and bipolar disorder. He has completed several clinical trials investigating the effects of curcumin, saffron, and ashwagandha for the treatment of anxiety and depression in children and adults. Dr. Lopresti is also the founder of Personalised Integrative Therapy, and regularly conducts educational workshops both nationally and internationally.